Individual
MS. SUSAN KAY HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1110 COLLEGE DR, SUITE 215, BISMARCK, ND 58501-1207
(701) 471-1044
Mailing address
200 E MAIN AVE, SUITE 102-A, BISMARCK, ND 58501-3857
(701) 471-1044
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
513
ND
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016133
BCBS OF ND PIN
—
05
—
19187
—
ND
01
—
N16133
RR MEDICARE PIN
—
Enumeration date
06/12/2006
Last updated
08/15/2010
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